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A local security official said a coast guard vessel on Thursday stopped a boat sailing inside Yemeni waters near Perim Island. The coastguards who boarded the boat found thousands of ammunition rounds in large plastic bags and unnumbered AK47 assault rifles hidden inside. The official said the three Yemeni crewmen, who come from different Red Sea coastal areas, were arrested. He said the three Yemenis were part of a large network involved in smuggling weapons from different countries, including Iran, to Yemen and other places. The official did not say if the seized ammunition and rifles were sent from Iran. In June, coastguards in the Red Sea seized a small boat loaded with dozens of pistols and thousands of rounds. Also that month, five people were arrested after they were found hiding 40 kilos of cocaine in their boat and heading to Houthi-controlled areas. For the first time since the beginning of the war, the Yemenis have managed to repel incursions by Eritrean boats and intercept many shipments of weapons and drugs. In June, the Saudi-led coalition announced the seizure of two Iranian weapon shipments heading to the Houthis. In a separate development the Saudi ambassador to Yemen, Mohammed Al-Jaber, said that the separatist Southern Transitional Council STC had returned the seized money to the central bank in Aden after the government agreed to pay military and security forces following a successful Saudi mediation. Government and STC officials are engaged in extensive talks in Riyadh, brokered by Saudi Arabia, to discuss ending hostilities in southern Yemen and putting into place the Riyadh Agreement. In northern Yemen the Defense Ministry said that government forces, backed by Saudi-led coalition warplanes, assaulted Houthis in Qania in the central province of Al-Bayda. Source: Arab News. Since November , the Red Sea has faced severe maritime disruptions due to attacks on commercial.. General Enquiries Contact Us Here. Maritime Security gulf of aden Yemen. Share article. Related Posts. Channel 16 Channel Cross-Strait relations in the Lai era On May 20, Lai Ching-te was inaugurated as Taiwan's new president, prompting significant military
User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen
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Official websites use. Share sensitive information only on official, secure websites. Correspondence: m. Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor. Keywords: community pharmacy, drug misuse, OTC drugs, non-prescription, prescription, qualitative experience, Yemen, violence. The misuse of medicinal products, both prescription and over-the-counter OTC , is of increasing concern globally \[ 1 , 2 \]. This may be related to their increased availability, inexpensive cost, and perceived safety \[ 3 , 4 \]. Moreover, since , stable or downward trends for traditional illicit drugs heroin and cocaine have been observed among major regions of consumption worldwide, but offset by an increase in synthetic and prescription drug use \[ 5 \]. Access to medicinal products is subject to a variety of controls, which are decided at individual country level. Typically, in many countries, a prescription is a written instruction made by a medical doctor. Again, restrictions vary, with some medicines being limited for sale by a qualified pharmacist while others are available for purchase in retail outlets, such as grocery stores. There are several reports in the literature of prescription-only medications being sold without prescription in many countries and online \[ 6 , 7 \]. Typically, in some countries of the Middle East and Africa, which are regions with political instability, war, and civil unrest, lack of social stability and safety for individuals are likely to be drivers for substance use. Although legislation does exist in these regions around medication supply, in many cases it is not strictly enforced. One can usually buy almost any medication, with the exception of narcotics and major tranquilizers, from community pharmacies \[ 8 \]. Like in other countries in the region \[ 8 , 9 \], the problem of dispensing medications that are liable for abuse without a valid prescription is a problem in Yemen \[ 10 \]. Such drugs include analgesics, antibiotics, antipsychotic drugs, cardiovascular drugs, and others \[ 8 \]. Medicinal drugs are not the only substances of abuse in Yemen. Khat chewing is legal, socially acceptable, and is a risk factor for the misuse of other drugs in the Yemeni community \[ 11 , 12 \]. Khat Catha Edulis is a plant that contains an alkaloid, cathinone, an amphetamine-like stimulant that is believed to cause excitement, loss of appetite, and euphoria. It is commonly used as a social drug in the African horn and nearby countries like Yemen. In Aden in particular, the problem of drug abuse is increasing, which has been linked to an increase in violence and crime in the last three years \[ 16 \]. Studies about drug abuse and misuse in Yemen are still scarce \[ 17 , 18 \]. In one cross-sectional survey of community pharmacists in Aden, Most commonly reported medications of abuse were Alprazolam, Ketoprofen, and Tramadol. The majority of suspects of prescription and non-prescription drug abuse Qualitative research complements quantitative work, so in order to help to build a wider picture of prescription and OTC drug abuse and misuse in Yemen, this study was implemented. Moreover, this study investigated the role if any that users thought health care providers could have in prescription and OTC drug misuse. Recruitment was undertaken between April and September Pharmacists acted as gatekeepers to potential participants, introducing them to the researcher who took consent see later. Community pharmacies were selected in different areas of Aden based on previous personal knowledge. The community pharmacy was chosen as a safe and trusted recruitment point, where the researcher EA could approach suspected drug misusers and ask them to take part in the study. Pharmacies in areas of particular instability and violence had to be excluded for the personal safety of the researcher. Due to safety and security issues as part of the political and social situation in Aden city, recruitment of subjects was considered difficult and risky. The safety of the researcher, a young woman, had to be considered in the design of this study. Thus, the following approach was taken: Interviews were conducted during the daytime. The researcher EA excluded those who were visibly carrying weapons, or those who appeared to be intoxicated or under withdrawal symptoms. Verbal consent to participate and audio-record the interviews was obtained. Interviews were conducted seated around a table in a quiet area inside the pharmacy, with the exception of pharmacies with no air-conditioner, where, for the purpose of comfort, interviews were conducted in the open air just outside the main entrance. Interviews were not conducted in private rooms, as the researcher was accompanied by 2 male relatives all the times. In order to minimize potential bias that the presence of bodyguards could induce, participants were intentionally not informed of their presence. To further minimize bias, participants were assured of confidentiality and that the pharmacist would not be given information on what they said. The interviews were all conducted in Arabic. A topic guide directed the interviews provided by the author upon request. Data analysis was undertaken concurrently with data collection and continued until no new themes were being raised. Interviews were transcribed in Arabic and checked for accuracy by EA. Transcription and translation into English was also done by EA. For a sample of five transcripts, another researcher MW compared the translated English scripts with the original Arabic ones, back-translating them from English to Arabic. EA and MW then compared the original with the back-translated transcript and discussed consensus on accuracy. Thematic analysis was undertaken \[ 20 \], guided by the research aims \[ 21 \]. Salient quotes which illustrate the findings were identified and attributed to made-up initials. The precise steps employed in the qualitative analysis of interviews are summarized in Table 1. The transcriptions were independently analyzed by MW. EA and MW then compared their themes and subthemes and reached consensus through discussion to confirm the final results. The precise steps employed in the analysis of interviews with suspected drug abusers in Aden \[ 21 \]. There is no research ethics approval system in Yemen, so no local approvals could be sought. The work was done as an MSc project. All participants were assured of confidentiality and anonymity, and that they could contact the main researcher EA and withdraw from the study at any time prior to data analysis. Audio recordings were destroyed after analysis was complete. Data saturation was achieved after interviewing fifteen participants reported to be misusing OTC or prescription drugs. Interviews lasted in total between 30—50 min. Three female addicts declined participation because of social reasons. Table 2 summarizes the demographic details of the interviewees. Case numbers and demographic characteristics of suspected prescription and over-the-counter OTC drug abusers in Aden. Four main themes were identified during the interviews: 1 The pattern and methods of misuse; 2 the role of healthcare professionals in responding to misuse; 3 experience sought with drugs; and 4 awareness of problematic drug use. A number of subthemes emerged, such as different sources and street names of drugs, experimenting with different preparation methods and mixtures of OTC drugs with Khat or alcohol to enhance effects, in addition to using different methods e. Drug misuse was very much related to Khat use; almost daily Khat consumption was accompanied with daily drug use. Three participants were an exception in this study, as they used drugs only, with no Khat. In the case of psychoactive drugs, the majority were increasing the drug dose to get the same effect, while stable doses of analgesics Ketoprofen, Ibuprofen, and Paracetamol were noted. Three methods of mixing drugs with Khat were noted: 1 Grinding the drug tablets e. A common barrier to buying prescription medicines without a prescription was the pharmacist either refusing to sell the medicines or hiding them away from sight. The misusers would then make contact with dealers:. However, others could get prescription-only medicines without a prescription as long as the pharmacist was known to them. T, 35 M, Engineer, Mix. Violence towards pharmacists was also reported. Some participants cited examples of weapons being used to force pharmacists to sell prescription medicines. Threatening pharmacists to steal drugs or money was also mentioned. Interviewees were asked if they had visited a physician for some medical reason, and whether the physician had noticed or suspected drug misuse. Most felt that their doctors never suspected their misuse of drugs, but focused only on their Khat consumption. Some interviewees did report that their doctor noticed their misuse of drugs and advised them directly or indirectly about the risks of these drugs. Participants thought that sometimes doctors do not like to ask about misuse or to get involved for safety reasons. The doctor can do nothing… Doctors are usually afraid to talk to families and even to us, because of weapons. Drug dealers and friends were the main sources of supply of drugs for about half of the participants, with the rest stating community pharmacies as their main source. OTC analgesics, such as Ketoprofen and Paracetamol, were reported to be easier to obtain, since they were available in supermarkets and grocery shops. Drug dealers were reported to be prevailing in low socioeconomic areas and to be well-known to people, especially in Khat-selling areas. Drug effects sought by participants varied, based on the drug and the dose used and whether they mixed it with Khat or not. However, all who were combining Alprazolam with Khat had almost the same description for the experienced effect, as illustrated by ES:. I forget everything at the same time feel powerful and everything is under control. The taste of Khat gets better. But sometimes with high dose I lose the ability to walk. As for Tramadol, the experienced effect depended on whether it was mixed with Khat or not, and the motivation was different. Those who were taking it without Khat actually sought pain relief, and then discovered its relaxing effect. On the other hand, some Khat chewers took Tramadol in combination with Khat for mental-altering effects, as in the following case:. Clonazepam was felt to have the most potent effect when mixed with Khat, and its withdrawal symptoms, such as aggression, were obvious the following day. Regarding OTC drug misuse Chlorpheniramine and Ketoprofen , two interviewees had different motivations and reasons to use it with Khat:. The majority of interviewees did not consider that they had experienced any unwanted effects, while some reported hypotension, vomiting, dizziness, loss of consciousness, and renal colic reported by those using Ketoprofen and Khat. One participant reported falling down due to severe hypotension, and required I. V fluids. Another participant described an overdose in three of his friends after a high dose of Clonazepam. My best friend broke my lower jaw, suddenly next day came and hit me for no reason. The main reasons for continuing to misuse Alprazolam, Tramadol, and Clonazepam were similar e. This was related to the type of drug used and individual characteristics. On the other hand, there were those who were afraid of addiction and had been trying so hard to stop use or find an alternative. Restyl brand name of Alprazolam is ok with me, and better than getting addicted to alcohol. Reported drug-seeking behavior differed depending on the type of drug. OTC analgesics e. On the other hand, for Tramadol, some of interviewees had to lie to get money or to steal from their families to obtain it. Few participants reported using their guns, and threatening pharmacists to steal drugs or money. This study was the first to provide in-depth qualitative data on the experience of prescription and OTC drug misusers in Aden, Yemen. It further explains the findings reported in the quantitative part of the study, which reported the mixing of drugs with Khat \[ 19 \]. The only substance mentioned previously in the literature to be mixed with Khat was tobacco \[ 11 \], and this was attributed to the claimed analgesic effects of tobacco, which may have masked the pain of Khat chewing \[ 22 \]. This study showed, for the first time, OTC analgesics such as Ketoprofen to be used to treat mouth pain from Khat chewing. Unpleasant physical withdrawal effects, aggressiveness, and psychological symptoms were reported by participants. This suggests that any interventions to address Khat use need to be cognizant of the possibility of polydrug use and dependence. The study also shed light on violence in pharmacy practice, especially in areas of armed conflict. This has not previously been reported in the literature. Carrying traditional weapons, such as Jambia dagger , is part of the traditional Yemeni costume. Moreover, the spread of guns and modern weapons has been increasingly prevalent in the last few years \[ 23 \]. Similar violence and aggression among drug misusers has been reported in other studies in different parts of the world \[ 24 , 25 \]. This violence was also reflected in the perception that doctors and pharmacists were afraid to challenge or counsel individuals suspected of drug misuse. Manchikanti et al. Also, it is believed to be very unlikely for interventions or health advice to be offered in a violent atmosphere \[ 25 \]. There have currently been no studies in Yemen that look at drug abuse among health care professionals. However, this risk was evident in this study by the inclusion of two participants who were a doctor and a pharmacist respectively. Similar reasons have also been reported for misuse of drugs by pharmacists and pharmacy students \[ 29 , 30 \]. The combination of sedatives with stimulants was commonly reported during Khat sessions amongst participants. This reflects similar polydrug use findings reported in Ethiopia and Kenya, where Khat chewing was frequently mixed with alcohol and benzodiazepine use \[ 31 , 32 \]. The mixing of Khat, which has stimulant properties, with sedatives, including alcohol and benzodiazepines could heighten risk \[ 33 \], as the user may find the sedation of the benzodiazepines is counteracted by the Khat. Additionally, the risks of combining two sedatives such as alcohol and benzodiazepines may not be felt. This might result in the person consuming sedatives beyond his limits, leading to sedative overdose \[ 34 \]. Risky behaviors by drug misusers in Yemen were also described; for example, the ignorance of the contents of drugs prior to consumption in combination with Khat. There were reports where the name of the drug taken was not known, suggesting a likely lack of access to information on risk and potential harms. Similarly, a lack of acknowledgement of addiction despite the reporting of addictive behaviors was evident amongst participants. Most interviewees in this study denied having a problem with drugs. Addiction denial is a recognized behavior at some stages of dependence \[ 35 \]. This denial is reported to be reduced when addicts are following a rehabilitation program \[ 36 \], presumably because those who enter rehabilitation have contemplated their problem and have motivation to address it. It may, however, be that the context of this study prevented disclosure of addiction. This is a very sensitive issue, and participants may have felt that disclosure might impede their ability to buy prescription or OTC medicines in the pharmacy where they were recruited. None of the participants in this study reported being in any kind of treatment or rehabilitation program. This study suggests there is potential for greater prevention and harm reduction advice to be given to people at risk of drug misuse in Yemen. Further work is needed to establish whether pharmacists and doctors could play a role in the provision of such advice, and to map the potential for such intervention development and evaluation \[ 38 \]. This study also highlights the social nature of prescription and OTC drug misuse amongst participants. It showed that being with friends in a Khat session plays an important role as a motivation factor for misusing other prescription or non-prescription drugs, whether to enhance the euphoric effect of the Khat \[ 30 \], or to mask Khat chewing problems such as mouth pain, as reported in this study and other studies \[ 33 , 34 \]. This suggests that interventions to discourage prescription and OTC drug misuse in Yemen need to take the context of Khat sessions into account and provide information and support appropriate for this social setting. Harm reduction advice could include discouraging the removal of medicines from their packaging to allow identification, accompanied by the provision of clear information on risks and harms. It has provided novel descriptive information on prescription and OTC medicine consumption, mixed with the more traditional use of Khat to either heighten the psychoactive experience or to combat pain from Khat chewing. It also describes violence as a barrier to effective pharmacy practice, something not previously noted in the literature. The sample recruited in this study varied in age, gender, level of education, and occupation. It included elderly people, females, and health care professionals. These groups can be difficult to recruit because of the sensitivity of the issue in Yemeni culture, so their representation is a strength point of the study. Moreover, carrying out such a study about a stigmatizing issue in a war zone like Yemen was a great risk that would add to the strength and novelty of this study. The main limitation of the study was the challenges in recruitment, which was slow and had to rely on convenience and snowball sampling due to the difficult-to-reach nature of the sampling frame and the stigma associated with drug misuse. Many people were hesitant to take part, despite the assurance of confidentiality and anonymity of data. Although every effort was made not to mention the faculty of pharmacy at which the researcher was based, they knew the researcher was a pharmacist and therefore the risk of social desirability bias cannot be excluded. The unsecure conditions in Aden at the time of carrying out the study meant the researcher had to be accompanied by two male relatives, which may be criticized as having the potential to impede the free speaking of participants. Similarly, data were not collected in a private room, but rather in a quiet corner of the pharmacy. There also has to be caution in assuming the implications of such practice on research collected in a Western setting would translate to the Yemeni context. The researcher was a lone female and, in the Yemeni context, the closed-door environment of a private room would not be acceptable. Finally, the study was conducted in Aden, the biggest urban center in the south of Yemen. It was qualitative in nature, seeking to understand experiences and not to quantify them. Therefore, the results are not generalizable across Yemen. This study qualitatively describes the experience of misusers and abusers of prescription and non-prescription drugs in Yemen. Most users do not contemplate their behavior as an addiction problem. Mixing Khat with drugs is common and takes place for different reasons. The lifestyle, culture, and political situation are all complicating factors for health care interventions and evaluation. Authors would like to thank all the community pharmacists and their patients who agreed to take part in the study. Conceptualization, E. As a library, NLM provides access to scientific literature. Pharmacy Basel. Find articles by Ebtesam A Abood. Find articles by Jenny Scott. Find articles by Mayyada Wazaify. Step 1 For each interview, transcripts were read, re-read and summary notes were made and grouped, under potential thematic categories. Step 2 As analysis progressed, the points of interest were reorganized and categorized under different themes, which were often renamed when a more appropriate title emerged. Step 3 Thematic analysis was carried out as themes were encountered on each tape, with particular attention being paid to any cases which agreed with existing themes Pope et al. Negative cases or alternative explanations were also sought, in order to confirm the themes identified from each separate interview. Step 4 Attention was also paid to whether themes were common across the interviews or were specific to one interview, in order to note any patterns emerging from the data. Any new themes that emerged were also noted and some themes were grouped together or recategorized to better fit the data. Step 5 This resulted in the production of a more definitive list of emergent themes, which were felt to reflect the data produced from the interviews. Step 6 The transcriptions were independently analyzed by another researcher MW and, when both researchers had reached consensus, these analytic themes were confirmed and translated into an account of the shared experience among the participating pharmacists. Open in a new tab. Married 4 Single 6 Divorced 5 Secondary undergraduate 4 Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Step 1. For each interview, transcripts were read, re-read and summary notes were made and grouped, under potential thematic categories. Step 2. As analysis progressed, the points of interest were reorganized and categorized under different themes, which were often renamed when a more appropriate title emerged. Step 3. Thematic analysis was carried out as themes were encountered on each tape, with particular attention being paid to any cases which agreed with existing themes Pope et al. Step 4. Attention was also paid to whether themes were common across the interviews or were specific to one interview, in order to note any patterns emerging from the data. Step 5. This resulted in the production of a more definitive list of emergent themes, which were felt to reflect the data produced from the interviews. Step 6. The transcriptions were independently analyzed by another researcher MW and, when both researchers had reached consensus, these analytic themes were confirmed and translated into an account of the shared experience among the participating pharmacists. Private business.
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